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Mediclinic News : Prevalence of chronic diseases in the population covered by medical schemes in South Africa

Title

Prevalence of chronic diseases in the population covered by medical schemes in South Africa

Date

2017-02-28

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News Description

COUNCIL FOR MEDICAL SCHEMES The Council for Medical Schemes conducted a trend analysis study on chronic diseases in the private healthcare sector for the period 2010 - 2015. The main finding of the study is that there has been a sustained upward trend in diagnosis and treatment of many chronic conditions on the Chronic Disease List. The top 10 ranking of chronic conditions according to prevalence rates did not change significantly between 2014 and 2015. Executive Summary The Medical Schemes Act, 131 of 1998 makes it mandatory for medical schemes to cover costs for the diagnosis, treatment or care of a defined set of benefits or Prescribed Minimum Benefits (PMBs), regardless of the benefit option members have selected. PMBs include any medical condition which meets the definition of an emergency, a limited set of 270 medical conditions and 26 chronic conditions defined in the Chronic Disease List (CDL). The CDL specifies medication and treatment for the chronic conditions that are covered as PMBs. This law ensures that beneficiaries with chronic conditions are not risk-rated. The CMS conducted a retrospective study of the CMS Scheme Risk Measurement (SRM) database to establish changes in the frequency of chronic diseases among beneficiaries of medical schemes between 2010 and 2015. This study is an update of the “Prevalence of chronic diseases in the population covered by medical schemes in South Africa” published by CMS in December 2015. For the first time in 2015, the CMS also analysed data on a more relaxed definition of prevalence as opposed to the SRM definition of prevalence. The findings of this study indicate that in 2015, the upward trend in diagnosis and treatment of many conditions on the chronic disease list continued. The top 10 ranking of chronic conditions according to prevalence rates did not change significantly between 2014 and 2015. The top 10 ranked CDL’s and HIV/AIDS (chronic conditions with the highest prevalence rates) are hypertension, hyperlipidaemia, diabetes mellitus 2, HIV/AIDS, asthma, hypothyroidism, coronary artery disease, cardiomyopathy, epilepsy, and bipolar mood disorder. The CDL’s listed as top 10 ranking CDL’s had prevalence rates of at least 3 per 1 000 beneficiaries in 2015. Hypertension, hyperlipidaemia and diabetes mellitus 2 continued to be the highest prevalent CDL’s in medical schemes beneficiaries with the prevalence of more than 20 per 1 000 beneficiaries. HIV/AIDS moved one position down from being the fourth ranking CDL to being the fifth ranking condition in medical scheme beneficiaries. Hypertension retained its rank as the highest prevalent CDL in medical schemes beneficiaries with an overall prevalence rate of 96.05 per 1 000 beneficiaries in 2015. Hypertension prevalence increased by 7.8 percent in 2015 as compared with 2014. Over the period between 2010 and 2015, hypertension prevalence increased by 27.9 percent resulting in the average annual growth rate of five percent per year for the period. The growth in hypertension prevalence has been consistent in open and restricted schemes for the period under review. Hyperlipidaemia continued to be the 2nd ranked CDL in terms of prevalence despite the prevalence rate decreasing by -1.4 percent between 2014 and 2015. Between 2010 and 2015, the prevalence of hyperlipidaemia increased by 12 percent resulting in an average growth rate of 2.3 percent per year for the period under review. Diabetes mellitus type 2 is still the 3rd ranked CDL in terms of prevalence. Between 2010 and 2015, prevalence of diabetes mellitus type 2 increased by 53.8 percent (from 20.29 to 31.21 per 1 000). This represents an average growth rate of nine percent per year for the period between 2010 and 2015. HIV/AIDS ranked the 5th chronic condition in terms of prevalence. Between 2010 and 2015, treated HIV/AIDS prevalence increased by about 82.4 percent. This resulted in the average growth rate of about 12.8 percent per year for the period under review. The treated HIV/AIDS prevalence declined from 20.96 per 1 000 beneficiaries in 2014 to 16.40 per 1 000 beneficiaries in 2015 (resulting in a year on year decrease of -21.8 percent). This is a worrying factor as the decrease was not expected. This decrease needs to be interpreted with caution as this may be a data quality issue. The number of medical scheme beneficiaries who were diagnosed and treated for multiple CDL conditions continued the upward trend in 2015. This might have a negative impact on the risk profiles of medical schemes. The deterioration in risk profiles should be a concern for medical schemes. The upward trend in diagnosis and treatment of many chronic conditions on the CDL continued in 2015. This study is not yet in a position to isolate specific reasons for this increase in chronic diseases, the trend could still be generally attributed to improved data management systems of medical schemes and administrators, the deteriorating disease profile and increased beneficiary awareness of entitlements and changes in care-seeking behaviour. A copy of the full report can be found at: http://www.medicalschemes.com/files/Research%20Briefs/researchBrieef.pdf
Created at 2017/03/08 04:29 PM by Mediclinic
Last modified at 2017/03/08 04:29 PM by Mediclinic